Remote Medical Management Nurse - Utilization & Case Review

Elevance Health; Atlanta (GA); A distancia; USD 90.000 - 115.000; Jornada completa

Descripción de la vacante

Elevance Health is seeking a Medical Management Nurse to review complex cases, applying nursing judgment and clinical guidelines to determine medical necessity. The role emphasizes collaboration with healthcare providers, consultation with the Medical Director, and ongoing participation in quality and process improvement initiatives.

The position operates virtually full-time with required in-person training sessions and adheres to a hybrid/virtual work policy.

Formación

• Requires an associate degree in nursing.
• 4 years’ care/case management experience and 2 years clinical/utilization review or managed care experience.
• Current active, valid RN license in applicable state(s).
• Multi-state licensure is required if providing services in multiple states.

Responsabilidades

• Utilizes nursing judgment to analyze members’ clinical information and assess medical necessity.
• Collaborates with healthcare providers to understand and assess a member’s clinical picture.
• Consults with the Medical Director on complex or unclear cases.
• Provides nursing consultation to Medical Directors and/or providers on select cases.
• Acts as a resource for clinicians and participates in process improvement activities.

Conocimientos

RN license

Clinical judgment

Case management

Multistate licensure

Collaboration

Educación

Associate’s degree in nursing

Descripción del empleo

Elevance Health is seeking a Medical Management Nurse to review complex cases, applying nursing judgment and clinical guidelines to determine medical necessity. The role emphasizes collaboration with healthcare providers, consultation with the Medical Director, and ongoing participation in quality and process improvement initiatives.

The position operates virtually full-time with required in-person training sessions and adheres to a hybrid/virtual work policy.